| objective:To investigate the antihypertensive effect of spironolactone of resistant hypertension and its effects on serum potassium of patients by searching the randomized controlled trials and conducting a meta-analysis. Methods: Searched in the Embase, Cochrane, Pubmed, and CNKI databases using two methods, including Medical Subject Heading(Me SH)terms and keywords terms, such as the following keywords :(“hypertension”and(“resistant to conventional”or “resistant” or “drug resistant”)) and(“spironolactone ”or “verosipone” or “SC 9420”), and searched the conference papers and included studies' conferences by hand. Randomized controlled trials which explore the antihypertensive effect of spironolactone of resistant hypertension patients would brought into our meta-analysis; and excluded case reports, animal experiments,duplicated publications, reviews and abstracts; two researchers reviewed all the articles and used the Jadad standards to evaluated the quality of studies independently; if a discrepancy was noted, we discussed to make a decision or decided by third one;data related to this study were extracted according to data extraction table;data were summarized by Review Manager 5.3 and Stata 12.0 software. Q test and I2 statistic were used to detect the heterogeneity(we set P=0.1 and I2=50% as the statistically significant data);we used fix-effect model or random-effect model to calculate combined effect and 95%CI;we made sensitivity analysis by taking out a paper every time to analyze the effect of each study for the total effect,and found out the source of heterogeneity.The funnel plot and Egger test were used to evaluated the degree of publication bias. Results:There were 186 studies in total,and 42 come from Cochrane,76 come from Embase,58 come from Pubmed and the rest 10 come from CNKI; of those,6 studies met the eligibility criteria,the Jadad score was 4 to 7;of 612 patients screened in 6 trials(spironolactone /placebo,306/306),for blood pressure outcomes,the meta analysis results showed that spironolactone could reduce systolic pressure(WMD =-13.13, 95%CI=-18.29--7.96;PH< 0.00001;I2=89%) and also diastolic pressure(WMD=-4.68, 95%CI=-7.07--2.28;PH=0.001,I2=75%),but there was high heterogeneity,1 study was fund to be the main source of heterogeneity after a sensitivity analysis, after removing this study the pooled effect(SBP/DBP: WMD=-10.35,95%CI=-12.07--8.63;PH=0.35,I2=10%/WMD=-3.43, 95%CI=-4.86--2.17;PH=0.32,I2=15%) was obviously different from before, and the heterogeneity obviously decreased, the second kind of result was more statistical significance. 5 studies were analyzed to evaluate the effect of spironolactone on serum potassium,including 497patients(spironolactone /placebo,249/248),the result showed that spironolactone has small influence on serum potassium(WMD=-0.04,95%CI=-0.35-0.04;PH<0.00001,I2=96%) and the difference between spironolactone group and placebo group was no statistical significance; sensitivity analysis showed that the result about blood pressure was stable, and the result about serum potassium was not stable; funnel plot and Egger test showed there was no publication bias between the studies about blood pressure, but publication bias was found between the studies about serum potassium. Conclusion: 1.Spironolactone could reduce systolic pressure in resistant hypertension patients, and also reduce diastolic pressure. 2. Spironolactone is not obviously higher potassium, but this result is not stable, we should be cautious about it. |
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